guide to time studies for the - ohio study guide.pdf · conjunction with the medicaid...

Guide to Time Studies for the

Ohio Medicaid School Program (MSP)

7/1/2014

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Introduction

The purpose of this guide is to provide direction for conducting time studies for the Ohio

Medicaid School Program (MSP), which includes Medicaid administrative costs. The guide has

been developed to explain the methodology and process for conducting time studies to support

the financial reporting and claiming that are associated with MSP. It should be used in

conjunction with the Medicaid Administrative Costs Methodology Guide, the Guide to Cost

Reporting for the Ohio Medicaid School Program, and the Guide to the Ohio Medicaid School

Program.

Purpose of the Time Study

A time study is a tool used to analyze work being done by employees/contractors over a

specified time period. The end result of the time study is a series of percentages reflecting the

proportion of time spent on the various types of activities performed by the

employees/contractors. When the time study is conducted across a sample of

employees/contractors, the results are used to extrapolate to the entire specified population of

employees/contractors.

The time study information collected as part of the process described in this guide will be used

for two specific purposes as follows:

Medicaid Administrative Costs: For the Medicaid administrative activity costs, time

study information is used to actually support the reimbursement made by the school

provider. Three key components go into the defining Medicaid administrative costs. The

total Medicaid reimbursable administrative activities is computed for each cost pool.

Then for each cost pool, the respective time study percentage is applied. Also, important

to the computation is the Medicaid Eligibility Rate (MER) – in other words, the

percentage of the total student population comprised of Medicaid eligible recipients. As

these factors are properly manipulated, the result is the amount that a school provider can

seek for federal reimbursement as costs related to Medicaid administrative services. A

school district’s MER will be calculated annually and the MER will be applied to codes

10, 12 and 14.

Direct Service Cost Reporting: The time study data are used as part of the year-end

cost-reporting process. Cost reports are designed to allow school providers to reconcile

payments for service claims made throughout the year to actual costs incurred. Similar to

the Medicaid administrative activities data, cost reporting involves the use of cost data

and time study data Also needed is the IEP utilization rate which is the ratio of students

with IEPs that are Medicaid eligible to the total number of students with IEPs. These

factors are used to compute total allowable direct service Medicaid costs for the school

provider. These computed amounts are then compared to claims paid. If the amount paid

is less than the cost, the school provider is paid the difference. If the amount paid

exceeds the total cost, the school provider must repay. The ratio of students with

Medicaid and IEPs to all students with IEPs will be calculated annually and applied to

codes 1 and 3.

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Time Study Administration

The time study will be administered by the Ohio Department of Education (ODE) on a statewide

basis under contract to another entity. The references throughout this document to the “time

study administering entity” means ODE or the entity contracted to perform the time study. The

Ohio Department of Medicaid (ODM) as the single state Medicaid agency will provide oversight

of the time study administration and technical assistance regarding time study requirements and

implementation issues.

NOTE: All training materials used by LEAs must be submitted for review and comment to the

time study administering entity.

Time Study Methodology

The purpose of the Ohio statewide time study is to (1) identify the proportion of administrative

time allowable and reimbursable and (2) identify the proportion of direct service time allowable

and reimbursable under Medicaid to be used for Direct Service cost reporting to enable the State

of Ohio to conduct a cost settlement at the end of the fiscal year in the MSP program. Staff

performing Medicaid related activities in a Local Education Agency (LEA) seeking

reimbursement will participate in a time study using the approved Random Moment Time Study

methodology.

Time Study Participants All LEAs that participate in the Time Study will identify allowable Medicaid direct service and

administrative costs within a given LEA by having staff who spend their time performing those

activities participate in a quarterly time study. These LEAs must certify that any staff providing

services or participating in the time study meet the educational, experiential and regulatory

requirements.

The time study contractor will collect a Participant List from each participating LEA through use

of an electronic upload system. On an ongoing quarterly basis, a current list of participants will

be sent to each LEA Program Coordinator before the start of the quarter. The coordinator will

update the list and return it prior to the start of each quarter.

Attachment A: Participant Categories specifies the categories of staff that have been identified

as appropriate participants for the Ohio time studies. Additions to the list may be made

depending upon job duties. The decision and approval to include additional staff will be made

on a case-by-case basis by program administrators based on approval granted by CMS.

All staff will be reported into one of three cost pools:

1. POOL 1 – Personnel who deliver Direct Medical Services, and who may deliver TCM

and/or perform administrative activities. Only the personnel that are credentialed

appropriately and who are approved in the State Medicaid Plan to provide direct services

in schools are included in this pool. All such personnel are licensed by cognizant state

licensing agencies.

2. POOL 2 -- Personnel not included in any other pool who provide TCM as specified in an

IEP. These individuals may also perform some administrative activities. In some cases,

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this pool will include employees or contractors who carry position titles listed as part of

Pool 3 (i.e. special education administrators).

3. POOL 3 -- Personnel who only perform administrative activities.

The three cost pools are mutually exclusive, i.e., no staff should be included in more than one

pool. The following provides an overview of the eligible categories in each cost pool.

Attachment B: Summary of Participant Categories Mapped to Cost Pools shows how the

categories of staff are divided into the three cost pools.

LEA personnel who are chosen to participate in the time study must be assigned to job categories

that describe their job function rather than a generic title that encompasses numerous types of

personnel (i.e., pupil support personnel). A miscellaneous group is not acceptable. If a category

does include a limited mix of job functions and titles, the functional (or working) job title must

be listed beside each person’s name. The LEA must maintain a complete job description on file

for each of these eligible positions.

The LEAs must certify that the list of staff they are submitting to be included in the eligible staff

pool are appropriate for inclusion in the time study and eventual claim. Staff deemed

inappropriate during review of time study quarters will be removed from the time study and

excluded from the claim.

Administrative staff such as executive directors, program directors, principals, assistant

principals, special education directors, and other managers/supervisory staff are not to be

included in the time study. Likewise, there should be no clerical or administrative support staff

included. These staff will be included in the claiming process by allocating their time and

appropriate costs based on the total time study effort.

Three mutually exclusive time studies, described below, will be conducted for the Direct

Services and Medicaid administrative activities. Although some staff may perform both direct

and Medicaid administrative activities related activities, they will only be allowed to participate

in one of the three time studies. For Direct Service staff that also performs TCM and/or

Medicaid administrative activities activities, the direct services time study will be used to

identify the claimable activities for both programs. Medicaid administrative activities claimable

time will only be included on a MSP cost report and will not be reimbursed through the Direct

Services Program.

The first time study and associated cost pool is generally comprised of direct service

staff, including those who conduct a combination of direct services, targeted case

management, and/or administrative activities as well as direct service staff only, and the

respective costs for the staff.

The second time study and associated cost pool is comprised of staff specifically

mentioned in a child’s IEP as providing targeted case management services, and who are

not included in any other cost pool but may also perform administrative activities.

The third time study and associated cost pool is comprised of administrative claiming

staff only and the respective costs for these staff.

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Therefore, the three groups of time study participants and associated cost pools are mutually

exclusive and the only direct costs that can be claimed under Medicaid related to this program

are derived from the three cost pools .

Random Moment Time Study (RMTS)

Upon CMS approval, the State will utilize a Random Moment Time Study (RMTS) methodology

at which time all LEAs who participate will be required to participate in the statewide RMTS.

RMTS is a federally accepted method for tracking employee time within LEAs. According to

OMB Circular A-87 (revised 5/10/04), and its accompanying implementation guide ASMB C-

10, “Substitute systems for allocating salaries and wages to Federal awards may be used in place

of activity reports. These systems are subject to approval if required by the cognizant agency.

Such systems may include, but are not limit to, random moment sampling….”

Random moment sampling or RMTS is particularly useful, because:

It uses a verifiable, statistically valid random sampling technique that produces

accurate labor distribution results, and

It greatly reduces the amount of staff time needed to record an individual time study

participant’s activities.

The RMTS method polls participants on an individual basis at random time intervals over a

given time period and totals the results to determine work effort for the entire population of

eligible staff over that same period. The RMTS method provides a statistically valid means of

determining what portion of the selected group of participant’s workload is spent performing

activities that are reimbursable by Medicaid.

RMTS Sampling Requirements

In order to achieve statistical validity, maintain program efficiencies and reduce unnecessary

district administrative burden, Ohio intends to implement a consistent sampling methodology for

all activity codes and groups to be used. Ohio has constructed the RMTS sampling methodology

to achieve a level of precision of +/- 2% (two percent) with a 95% (ninety-five percent)

confidence level for activities. While the 2003 Guide specifically allows for a 5% precision level

and this level meets both the Guide requirements and Ohio’s goals for an efficient and simplified

sampling process, the Ohio sampling methodology is constructed at the 2% precision level based

on preferences stated by the CMS statistician.

Statistical calculations show that a minimum sample of 2401 completed moments each quarter,

per cost pool, is adequate to obtain this precision when the total pool of moments is greater than

3,839,197. Additional moments are selected each quarter to account for any lost moments. Lost

moments are observations that cannot be used for analysis, i.e., incomplete moments or moments

selected for staff no longer at the LEA.

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The following formula is used to calculate the number of moments sampled for each time

study cost pool:

ss =

Z2 * (p) * (1-p)

c2

where:

Z = Z value (e.g. 1.96 for 95% confidence level)

p = percentage picking a choice, expressed as decimal

(.5 used for sample size needed)

c = confidence interval, expressed as decimal

(e.g., .02 = ±2)

Correction for Finite Population

Ss

New ss =

1+

ss-1

Pop

where:

pop = population

The following table shows the sample sizes necessary to assure statistical validity at a 95%

confidence level and tolerable error level of 2%. Additional moments will be selected to account

for unusable moments, as previously defined. An over sample of 15% will be used to account

for unusable moments.

N= Sample Size

Required

Sample Size

plus 15%

Oversample

100,000 2345 2697

200,000 2373 2729

300,000 2382 2739

400,000 2387 2745

500,000 2390 2749

750,000 2393 2752

1,000,000 2395 2754

3,000,000 2399 2759

>3,839,197 2401 2761

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RMTS Process

The RMTS process is described here as four steps:

1. Identify total pool of time study participants

2. Identify total pool of time study moments

3. Randomly select moments and then randomly match each moment to a

participant

4. Notify selected participants about their selection moments

1. Identify Total Pool of Time Study Participants

At the beginning of each quarter, participating LEAs provide a staff roster (Participant List)

to the time study administering entity providing a comprehensive list of staff eligible to

participate in the RMTS time study. This list of names is subsequently grouped into job

categories (that describe their job function), and from that list all job categories are assigned

into one of three “cost pools” for each LEA participating in the time study. There will be

three cost pools.

2. Identify Total Pool of Time Study Moments

The total pool of “moments” within the time study is represented by the calculating the

number of working days in the sample period, times the number of work hours of each day,

times the number of minutes per hour, and times the number of participants within the time

study. The total pool of moments for the quarter is reduced by the exclusion of weekends,

holidays and hours during which employees are not scheduled to work.

3. Randomly Select Moments and Randomly Match Each Moment to a Participant

Once compiled statewide, each cost pool is sampled to identify participants in the RMTS

time study. The sample is selected from each statewide cost pool, along with the total

number of eligible time study moments for the quarter. Using a statistically valid random

sampling technique, the desired number of random moments is selected from the total pool of

moments. Next, each randomly selected moment is matched, using a statistically valid

random sampling technique, with an individual from the total pool of participants.

Each time the selection of a minute and the selection of a name occurs, both the minute and

the name are returned to the overall sample pool to be available for selection again. In other

words, the random selection process is done with replacement so that each minute and each

person are available to be selected each time a selection occurs. This step guarantees the

randomness of the selection process.

Each selected moment is defined as a specific one-minute unit of a specific day from the total

pool of time study moments and is assigned to a specific time study participant. Each

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moment selected from the pool is included in the time study and coded according to the

documentation submitted by the employee.

The sampling period is defined as a three-month period comprising each quarter of the year.

The following are the quarters to be followed for the MSP:

October-December

January-March

April- June

July-September

Each quarter, Ohio will determine the dates that school districts will be in session and for

which their staff members are compensated. District staff members are paid to work during

those dates that districts are in session; as an example, districts may end the school year

sometime in May each year. All days including and through the end of the school year

would be included in the potential days to be chosen for the time study. It is important to

understand that although districts may end the school year prior to the close of the quarter

staff members are paid for services provided through the end of the fiscal quarter. Districts

typically spread staff compensation over the entire calendar year even when staff members

are not working. The district considers this compensation reimbursement for time when staff

members actually work rather than compensation for the staff members time off during the

summer months.

Each quarter, the State will determine the dates that each school provider will be in session

based on individual school provider calendars. All days including and through the end of the

school year would be included in the potential days to be chosen for the time study.

The total pool of moments within the time study is represented by applying each school

provider’s school calendar (most common start/end times for all schools within the school

district will be determined) to potential participants eligible to participate in the RMTS for

that school provider. The total pool of moments for the quarter does not include weekends,

holidays, hours during which employees are not scheduled to work, state testing days and

teacher work days.

Since activities and services are not provided in the LEAs when school is not in session,

Ohio will not conduct a time study for that time period school is not in session (typically

June through August). Ohio will rather use an average of sampling results from the three

previous sampling periods to calculate a claim for the period for which no services were

provided, thus, no time study was conducted. Ohio has determined that activities are not

performed in the summer time (typically the second week of June through the third week of

August) when districts are not in session.

4. Notify Participants about their Selected Moments

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Time study participants are notified via paper, email or other method, of their requirement to

participate in the time study and of their sampled moment. Sampled participants will be

notified of their sampled moment three days prior to their sampled moment. At the

prescribed moment, each sampled participant is asked to record and submit his/her activity

for that particular moment.

A validity check of the time study results will be completed by the time study contractor each

quarter prior to the calculation of the claim. The validity check ensures that the minimum

number of responses is received each quarter to meet the required confidence level. The number

of completed and returned time study moments is analyzed to confirm that the confidence level

requirements have been met. Once the validity of the sample has been confirmed, the time study

results are calculated and prepared for the calculation of the quarterly claim. The time study

contractor will provide ODE and ODM with a series of quarterly reports which include coding

that was completed for a randomly selected percentage of responses. In addition, the contractor

will provide ad hoc reports upon request.

At the end of each quarter, once all Random Moment data has been received and Time Study

results have been calculated, statistical compliance reports will be generated to serve as

documentation that the sample results have met the necessary statistical requirements.

Training Types & Overview

Three types of training will be conducted for RMTS (1) Program Contact Training, (2) Central

Coding Staff Training and (3) Sampled Staff Training. The following is an overview of each

training type.

1. Program Contact Training

The time study contractor, with participation by ODE, will provide initial training for the LEA’

Coordinators, which will include an overview of the RMTS program and information on how to

access data input mechanisms and input information into said mechanisms. These Program

Coordinators will then be responsible for conducting training of the selected time study

participants in their LEAs. It is essential for the LEAs’ Coordinators to understand the purpose

of the time studies, the appropriate completion of the RMTS, the timeframes and deadlines for

participation, and that their role is crucial to the success of the program. Participants are to be

provided detailed information and instructions for completing and submitting the time study

documentation of the sampled moment. All training materials will be accessible to Program

Coordinators initially via the time study administering entity’s website and/or any contracted

entity’s website. In addition, annual training will be provided to the Program Coordinators to

cover topics such as MAC program updates, process modifications and compliance issues.

2. Central Coding Staff Training (Activity Coding)

Central Coders will be employed by the time study contractor and will review the documentation

of participant activities performed during the selected moments and determine the appropriate

activity code. In a situation when insufficient information is provided to determine the

appropriate activity code, the central coder will contact the Program Coordinator at the

individual LEA and request submission of additional information about the moment. Once the

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information is received, the moment will be coded and included in the final time study

percentage calculation. All moments will be coded separately by at least two coders as part of a

quality assurance process. The moments and the assigned codes will be reviewed for

consistency and adherence to the state approved activity codes.

The time study contractor will provide training to the coding staff on an as needed basis, but at a

minimum annually to discuss issues surrounding the coding of moments. Training will include

an overview of activity codes, samples of activities, and appropriate processes for making coding

determinations.

On a quarterly basis, ODE will review a sample of the coding process and original participant

documentation for Quality Assurance purposes to show the data submitted in the time study

questionnaires support the code selected and therefore show the codes are valid and accurate. In addition to the quarterly review, at its discretion, ODE or ODM can review the completed

coding and original participant documentation at any time throughout the claim process or as

needed for further review or audit purposes.

3. Sampled Staff Training

The Program Coordinator for each LEA must ensure that sampled staff receives training prior to

their completion of the RMTS for their sampled moment(s). Since all RMTS responses will be

reviewed by Central Coders, and these Coders will subsequently select the appropriate activity

code, the staff training will focus on program requirements and the completion of the RMTS

survey. The staff training will not include an overview of activity codes since all coding will be

completed by Central Coders. The following items must be included in staff training:

Overview of the required process to participate in RMTS

Review the standards for RMTS documentation submitted by staff

Methods for requesting additional documentation from time study participants

when insufficient information is provided to centralized coders to determine the

appropriate activity code.

The training must be provided quarterly, staff that has not received training can

not participate in the RMTS.

LEAs must maintain documentation, that all staff participating in each quarter’s

time study received training.

It is required that any training materials used by LEAs be submitted for review

and comment to Ohio.

LEAs are encouraged to use and distribute any materials provided by the state

regarding the time study.

LEAs may use a variety of staff training methodologies. Some of these

methods include, but are not limited to, on-site trainings, video conferencing,

web-based, CD’s, videos, and self-training (only after the completion of some

form of interactive training has been completed).

NOTE: The time study contractor would provide assistance in the development of training

tools/documents or any additional needs that the LEA Program Coordinators have. All training

materials used by LEAs must be submitted for review and comment to the time study

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administering entity.

Documentation (RMTS)

All documentation of sampled moments must be returned within five business days after the

sampled date. Documentation of moments not received within the required time frame cannot be

used in the calculation of the necessary number of moments needed to satisfy the level of

precision of +/- 2% (two percent) with a 95% (ninety-five percent) confidence interval.

Documentation of sampled moments must be sufficient to provide answers to three

questions needed for accurate coding:

a. Who was with you?

b. What were you doing?

c. Why were you performing this activity?

In addition, sampled staff will certify the accuracy of their response prior to submission

Additional documentation maintained by the time study administering entity and its

contractor will include:

a. Sampling and selection methods used,

b. Identification of the moment being sampled, and

c. Timeliness of the submitted time study moment documentation.

Invalid moments are moments not returned by the LEA or moments that were not accurately

coded by the coders based on the review by ODE staff. Moments that have been inaccurately

coded will be returned for correction, and every effort will be made by Ohio to obtain the

corrected valid moment from the vendor.

Validation Method

Ohio is committed to collecting complete and accurate information through its statewide RMTS.

As such, it will require that 5% of all moments be validated by an independent observer. In Ohio

that responsibility will fall to the LEA Program Coordinator or Assistant Program Coordinator.

After the initial generation of moments, the time study administering entity will generate a sub-

sample of 5% of the moments. The moments will be flagged for validation. When a participant

responds to a moment in the sub-sample, the LEA Program Coordinator or Assistant Program

Coordinator for that district will validate the response.

Validation must occur within a week of the participant responding to the moment. The validation

cannot be conducted by the same person or entity that codes the responses.

Time Study Return Compliance

Ohio will require a state-wide response rate for the time study survey of at least 85%, and all

non-returned moments will be included and coded as non-Medicaid time. If the 85% compliance

rate is reached without having to code to non-Medicaid time, then non-returned moments will be

ignored since they are compensated by the 15% over sampling of the sample size.

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To assist in reaching the statewide goal of 85% compliance, Ohio will monitor the LEAs to

ensure they are properly returning sample moments and the LEA’s return percentage for each

quarter will be analyzed by Ohio. If an individual district has non-returns greater than 15% and

greater than five (5) moments for a quarter, the LEA will receive a warning letter from Ohio. If

the same LEA is in default (as defined previously) the next quarter after being warned, they will

not be able to participate in the time study for a one year period of time. For instance, if an

LEA has non-returns greater than 15% and greater than five (5) moments for the quarter

ended June 30, 2014 and December 31, 2014, the LEA will not be able to claim for the Fiscal

Year Ending June 30, 2009, and will need to return any interim payments sent to the LEA for

the fiscal year under the Direct Services Program.

Ohio will identify all non- returned moments and make every effort to find out why the moments

were not returned. Ohio staff will identify on a weekly basis the non returned moments and sort

by LEA. A list of these non returned moments will be sent to the LEA’s Program Coordinator

for response. Participants will be asked to explain why the moment was not completed and

returned, and will also be asked what they were doing at the time of the moment in question to

the best of their recollection. Ohio will then analyze this data to ensure that the non-returns are

reflective of the time study results. This data will not be included in the claiming process but

will be used only to insure that LEAs are not purposely withholding non Medicaid related

moments.

State Level Oversight and Monitoring of Time Study Administration

The Ohio Department of Education (ODE) will employ a Medicaid School Program (MSP)

Manager who will serve as the single point of accountability for oversight of the time study

contractor and monitoring various components of the MSP program. The areas that the

MSP Manager will review include, but are not limited to the following:

Participant List. The time study contractor will assure that LEAs submit only

eligible categories of staff based on the approved RMTS plan. The MSP Manager

will sample LEA staff listings to verify that the time study contractor has

appropriately performed this task. The contractor will submit to the MSP Manager

for review any exclusions to the LEA’s participant listing.

RMTS Time Study. The MSP Manager will review the contractor’s sampling

methodology, the sample and the time study results and document the outcome of

this review. The results of this review as well as any unresolved questions or issues

will be submitted to the contractor and to ODM as the single state Medicaid agency.

RMTS Central Coding. The time study contractor will review a sample of the

completed coding and the original participant documentation for coding accuracy

and validation and submit the summarized results to the MSP Manager with

recommendations. The MSP Manager independently may review a sample of

coding results, including excluded time study moments.

Training. The MSP Manager will assure that training requirements for LEA

Coordinators, Central Coders and participating LEA staff are being met by review

of training materials and attendance at various training sessions.

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Documentation compliance. The MSP Manager will review with the time study

contractor the results of any documentation compliance issues and take steps to

assure that a compliance plan has been completed and to monitor its results.

Frequency.

The local MSP Program Coordinator will submit to ODE a quarterly report status report in a

format provided by ODE, noting the time study activities occurring that quarter and any

difficulties with time study implementation. The MSP provider will submit to ODE an annual

report regarding local time study implementation signed by the school district superintendent.

ODE will summarize the quarterly and annual reports and forward the summaries with

recommendations for improving the local implementation process to ODM for review and

follow-up.

ODE’s MSP Manager in collaboration with ODM staff will monitor all local MSP

programs at least once annually. This monitoring will consist of either an on-site, desk or

combination review. For this annual monitoring process, one quarter will be selected for

in-depth review. Participating MSP providers will be required to fully cooperate in

providing information and access to necessary staff in a timely manner to facilitate these

efforts. MSP providers that do not fully cooperate in the review process may be subject to

sanctions by ODM.

For other quarters, trends will be examined, for example, total costs in the claim, time

study results, and reimbursement levels in relation to the school’s special education

population. Any significant variation from historical trending will be communicated to the

MSP providers for explanation of the variance.

Since MSP implementation began with the 2008-2009 school year, it is expected that MSP

activity will increase as the year progresses and the increase may continue into the

following school years. Therefore, the determination of a true base year for trending

purposes will require that expected enrollment and billings have been reached.

Remedial Action and Sanctions

ODM, upon the recommendation of ODE, may pursue remedial action for MSP providers

that fail to meet MSP program requirements or fail to correct problems identified during

review. Examples of actions that may cause implementation of sanctions include, but are

not limited to:

Repeated and/or uncorrected errors in financial reporting, including failure to use

the state provided financial reporting templates,

Failure to cooperate with state and/or federal staff during reviews or other requests

for information,

Failure to submit quarterly or annual implementation progress reports,

Failure to maintain adequate documentation, and

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Failure to provide accurate and timely information to ODE’s RMTS contractor as

required.

Failure to attend the required training.

Sanctions that Ohio may impose include placing MSP providers on “payment hold”,

conducting more frequent monitoring reviews, recoupment of funds, and ultimately,

cancellation of the MSP provider’s Medicaid provider agreement.

Required LEA Personnel

Each LEA must designate an employee as the Program Coordinator to provide oversight for the

implementation of the time study and to ensure that policy decisions are implemented

appropriately. The local agency must also designate an Assistant Program Coordinator to

provide back-up support for time study responsibilities.

Required Attendance of the Program Coordinators and Assistant Program Coordinators

Ohio requires one Program Coordinator attend the initial RMTS training. A minimum of two

people with a working knowledge of MSP are required to attend all mandatory Ohio training

sessions, following the initial training, as scheduled by ODE. This includes the Program

Coordinator and/or the Assistant Program Coordinator or at least one additional local agency

personnel with a working knowledge of MSP.

Time Study Activities/Codes

The time study codes assist in the determination of time and associated costs that are related to

and reimbursable under the Medicaid program. The time study codes have been designed to

reflect all of the activities performed by time study participants per LEA.

The time study codes are assigned indicators that determine its allowability, federal financial

participation (FFP) rate, and Medicaid share. A code may have one or more indicators

associated with it. These indicators should not be provided to time study participants.

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The following are the activity code descriptions for Ohio:

Activity

Code Activity Description

Medicaid

Rate

1 IEP Direct Medical Services

D-IEP

2 Non-IEP Direct Medical Services U

3 Targeted Case Management (IEP) D-IEP

4 Targeted Case Management (non-IEP) U

5 Other Educational and Social Services (Non-Medical

Services)

U

6 Medicaid Program Outreach ND

7 Outreach Non-Medicaid Program U

8 Facilitating Medicaid Program Eligibility

Determinations

ND

9 Facilitating Non-Medicaid Program Eligibility

Determinations

U

10 Referral, Coordination, and Monitoring of Medical

Services

D-MER

11 Referral, Coordination, and Monitoring of Non-

Medical Services

U

12 IEP Transportation Coordination and Translation for

Medical Services

D-MER

13 Non-IEP Transportation Coordination and Translation

For Non-Medical Services

U

14 Program Planning, Development, and Interagency

Coordination for Medical Services

D-MER

15 Program Planning, Development, and Interagency

Coordination for Non-Medical Services

U

16 Allocable General Administration R

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For purposes of the Medicaid School Program (including Medicaid administrative activities)

each activity is categorized into various types that drive how the percentage of time allocated to

that activity will be used in computing claims. These types are as follows:

1. Non-Discounted (Type ND) activities are administrative activities that are applicable

and reimbursable for the entire student population. Medicaid eligibility percentages are

not applied to these activities.

2. Discounted (Type D-MER) activities are administrative activities that are applicable to

the entire student population but are only reimbursable for the Medicaid eligibles in the

school provider population. The costs associated with these activities will be reduced

according to the Medicaid Eligibility Rate percentage in claim calculation steps.

3. Discounted (Type D-IEP) activities are direct service activities that are applicable to the

special education student population with Individual Education Programs (IEPs) but are

only reimburseable for the Medicaid eligibles with IEPs. The costs associated with these

activities will be reduced according to the ratio of students with IEPs and Medicaid to all

students with IEPs.

4. Unallowable (Type U) activities are unallowable activities under the Medicaid

Administrative claim, but these activities account for the balance of the sampled

participants' time. These activities are unallowable regardless of whether or not the

population served includes Medicaid eligible individuals. As required in OMB A-87, the

full spectrum of activities performed by the sampled participants is measured in order to

accurately account for all of the study participants' time.

5. Reallocated (Type R) applies to the activity code for general allocable administrative

activities. Time allocated to this activity is reallocated across the other activities.

Each activity code may be used to drive percent-of-time values that are used for the Medicaid

administrative activity/MSP cost reports.

Time Study Activity Definitions Detailed definitions of the time study activities can be found in Attachment D: Time Study

Activity Codes. Many different sources were used to support the development of detailed

definitions for Medicaid administrative functions, including administrative function definitions

in the 42 CFR Part 441, Subpart B (of Individuals Under Age 21), and HCFA/CMS approved

and/or reviewed Medicaid administrative claim materials employed in several other states.

Financial reporting

Financial information used to claim reimbursement is based upon actual expenditures obtained

directly from the participating entities' financial accounting system. All supporting

documentation will be made available by the claiming entities for an Agreed Upon Procedure

(AUP) by a Certified Public Accountant or Auditors of the State of Ohio.

16

Help, Comments and Suggestions

If you have any questions or need assistance, please send an e-mail to

[email protected]. Also, your comments about this guide or any other

components of the MSP and suggestions for ways to make it clearer or more understandable are

welcome at the same address. In addition information is available on the Medicaid School

Program page of the ODE website which may be accessed by going to http://education.ohio.gov

and typing “Medicaid” in the search box at the upper right hand corner.

mailto:[email protected]

http://education.ohio.gov/

17

Attachment A:

Participant Categories

PARTICIPANT CATEGORIES

Licensed Audiologists

Licensed Audiology Aides

Licensed Speech-Language Pathologists

Licensed Speech-Language Pathology Aides

Licensed Professional Clinical Counselors

Licensed Counselors

Licensed Registered Nurses

Licensed Practical Nurses (LPNs)

Licensed Occupational Therapists

Licensed Occupational Therapy Assistants (COTAs)

Licensed Physical Therapists

Licensed Physical Therapy Assistants

Licensed Psychologists

Licensed School Psychologists

Licensed Psychiatrists

Licensed Independent Social Workers

Licensed Social Workers

Targeted Case Management (TCM) Personnel (as specified

in an IEP and not included in any other category above, but

possibly titled in categories below)

Bilingual Specialists

Interpreters (Hearing Impaired)

Orientation & Mobility Specialists

Program Specialists

Psychology Interns

Special Education Administrators

Social Work Interns

Teacher Consultant

Professional Pupil Service License Holders – School

Psychologists/School Counselors

18

Attachment B:

Summary of Participant Categories Mapped to Cost Pools

COST POOL PARTICIPANT CATEGORY

POOL 1

Personnel who deliver

Direct Medical

Services, and who

may deliver TCM

and/or perform

administrative services

Licensed Audiologists

Licensed Audiology Aides

Licensed Psychiatrists

Licensed Speech-Language Pathologists

Licensed Speech-Language Pathology Aides

Licensed Psychologists

Licensed School Psychologists

Licensed Occupational Therapists

Licensed Occupational Therapy Assistants (COTAs)

Licensed Physical Therapists

Licensed Physical Therapy Assistants

Licensed Registered Nurses (RNs)

Licensed Practical Nurses (LPNs)

Licensed Professional Clinical Counselors

Licensed Counselors

Licensed Independent Social Workers

Licensed Social Workers

POOL 2

Personnel not included

in pool 1 who provide

TCM as specified in

an IEP. These

individuals may also

perform some

administrative services

Individuals specifically mentioned in a child’s IEP as

providing TCM services who are not included in any

other cost pool. This may include some special

education administrators and professional pupil

service license holders.

POOL 3

Personnel who only

perform administrative

services

Bilingual Specialists

Interpreters (Hearing Impaired)

Orientation & Mobility Specialists

Program Specialists

Teacher Consultant

Psychology Interns

Special Education Administrators (non-TCM)

Social Work Interns

19

Attachment C:

Summary of Activity Codes

Activity

Code Activity Description

1 IEP Direct Medical Services

2 Non-IEP Direct Medical Services

3 Targeted Case Management – IEP

4 Targeted Case Management – non-IEP

5 Other Educational and Social Services (Non-Medical Services)

6 Medicaid Program Outreach

7 Outreach Non-Medicaid Program

8 Facilitating Medicaid Program Eligibility Determinations

9 Facilitating Non-Medicaid Program Eligibility Determinations

10 Referral, Coordination, and Monitoring of Medical Services

11 Referral, Coordination, and Monitoring of Non-Medical Services

12 IEP Transportation Coordination and Translation for Medical

Services

13 Non-IEP Transportation Coordination and Translation For Non-

Medical Services

14 Program Planning, Development, and Interagency Coordination

for Medical Services

15 Program Planning, Development, and Interagency Coordination

for Non-Medical Services

16 Allocable General Administration

.

20

Attachment D:

Time Study Activity Codes (Note: Throughout these activity code descriptions, the term “Medical services” means those direct

medical services that when provided to Medicaid eligible recipients are covered under the Medicaid

School Program. While Medicaid covers the services for Medicaid eligible students, the services are also

likely being provided in the normal course of providing IEP services to non-Medicaid eligible students.

The relevant codes should be used based on the activity definition – regardless of whether it is provided

to Medicaid or non-Medicaid students. The “discounting” computational process will allocate these

activity categories proportionally to Medicaid and non-Medicaid students. When the term “Medicaid” is

specifically used, as in Codes 5, 6, 7, and 8 it means specifically for the Medicaid program only.)

CODE 1: IEP DIRECT MEDICAL SERVICES

This code should be used primarily by licensed direct service personnel when providing client

care, treatment and/or counseling services to an individual pursuant to the IEP in order to correct

or ameliorate a specific condition. Any activities billable to OMSP as direct services, except

TCM, should be included in this code, and should be appropriately documented.

Targeted Case Management services for children with a developmental disability and an

IEP should be coded as Code 3; targeted case management services for children without a

developmental disability and/or without an IEP should be coded as Code 4.

Examples of activities reported under this code:

All medical services indicated in the child’s IEP;

Other direct clinical/treatment services indicated in the child’s IEP;

Developmental assessments that lead to the development of an IEP;

Other diagnostic testing that leads to the development of an IEP;

Counseling, indicated in an IEP and provided to a student about a health, mental health,

or substance abuse issue;

Administering/monitoring prescribed injection or medication to a student in accordance

with an IEP. (Note: administration of a medication would only be allowable if indicated

on the student’s IEP.)

Conducting medical/health assessments/evaluations and diagnostic testing that

lead to the development of an IEP and preparing related reports.

Providing health care/personal aide services in accordance with an IEP.

Medical specialized transportation indicated in the child’s IEP.

21

CODE 2: NON-IEP DIRECT MEDICAL SERVICES

This code should be used primarily by licensed direct service personnel when providing client

care, treatment and/or counseling services to an individual NOT pursuant to an IEP in order to

correct or ameliorate a specific condition. Any activities billable to OMSP as direct services,

except Targeted Case Management, should be included in this code when provided to a student

NOT pursuant to an IEP, and should be appropriately documented according to the relevant

service rule. Targeted case management services for children without a developmental

disability and/or without an IEP should be coded as Code 4.


All billable medical services not indicated in an IEP;

Other direct clinical/treatment services not indicated in an IEP;

Developing a treatment plan for a student if provided as a service;

Developmental assessments that does not lead to an IEP;

Other diagnostic testing;

Counseling, not indicated in an IEP, provided to a student about a health, mental health,

or substance abuse issue;

Performing child health screens such as vision, speech, hearing and scoliosis;

Administering first aid, emergency care, or prescribed injection or medication to a

student.

Conducting medical/health assessments/evaluations and diagnostic testing and

preparing related reports.

Providing health care/personal aide services.

Transportation not included in Code 1.

22

CODE 3: TARGETED CASE MANAGEMENT (IEP)

This code should be used by all staff when providing targeted case management services to an

individual pursuant to the IEP.

Case management services are defined as those services identified as a Medicaid targeted case

management service in a child's IEP and delivered by a qualified case manager that will assist

the child in gaining access to medical, social, educational and other needed services relative to

the educational needs identified in the child's IEP. The amount, scope and duration of the case

management services, as well as the case manager responsible for providing the case

management service, should be indicated in the child's IEP. The components of the case

management services are:

Assessment

Care Planning

Referral and Linkage

Monitoring and Follow-Up

Examples of assessment activities for a child with an IEP include:

gathering of comprehensive information concerning the child’s preferences,

personal goals, needs, abilities, health status and other available supports;

determining the child’s need for case management;

obtaining agreement from the child’s parent/legal guardian to allow the

provision of case management;

making arrangements to obtain from therapists and appropriately qualified

persons the initial and on-going evaluation of the child’s need for any medical,

educational, social, and other services.

Examples of care planning activities for a child with an IEP include:

ensuring the active participation of the child and the child’s parent/legal

guardian and family;

working with the child’s IEP team to develop the IEP goals and course of

action to respond to the assessed needs of the child.

Examples of referral and linkage activities for a child with an IEP include:

connecting a child with an IEP to individuals capable of providing needed

medical, social, educational and other needed services.

Examples of monitoring and follow-up activities for a child with an IEP include:

23

ensuring that the IEP is effectively implemented and adequately addresses the

needs of the child;

conducting quality assurance reviews on behalf of the child and incorporating

the results of quality assurance reviews into amendments of the IEP;

reviewing the progress toward goals in the IEP and making recommendation

for assessment as appropriate based upon progress reviews;

ensuring that services are provided in accordance with the IEP and that IEP

services are effectively coordinated through communication with service

providers, including the Medical Home.

24

CODE 4: TARGETED CASE MANAGEMENT (NON-IEP)

This code should be used by all staff when providing targeted case management services to a

student when such services are provided but not pursuant to a child’s IEP. It is generally

understood that the provision of targeted-case management to a child without an IEP is

extremely rare.

Case management services are defined as those services delivered by a qualified case manager

that will assist the child in gaining access to medical, social, educational and other needed

services relative to the educational needs of the child. The components of the case management

services are:

Assessment

Care Planning

Referral and Linkage

Monitoring and Follow-Up

Examples of assessment activities for a child without an IEP include:

gathering of comprehensive information concerning the child’s preferences,

personal goals, needs, abilities, health status and other available supports;

determining the child’s need for case management;

obtaining agreement from the child’s parent/legal guardian to allow the

provision of case management;

making arrangements to obtain from therapists and appropriately qualified

persons the initial and on-going evaluation of the child’s need for any medical,

educational, social, and other services.

Examples of care planning activities for a child without an IEP include:

ensuring the active participation of the child and the child’s parent/legal

guardian and family in developing the care plan for the child;

Examples of referral and linkage activities for a child without an IEP include:

connecting a child without an IEP to individuals capable of providing needed

medical, social, educational and other needed services.

Examples of monitoring and follow-up activities for a child without an IEP include:

ensuring that the care plan is effectively implemented and adequately

addresses the needs of the child;

25

conducting quality assurance reviews on behalf of the child and incorporating

the results of quality assurance reviews into amendments to the care plan;

reviewing the progress toward goals in the care plan and making

recommendation for assessment as appropriate based upon progress reviews;

ensuring that services are provided in accordance with the care plan.

26

CODE 5: OTHER EDUCATIONAL AND SOCIAL SERVICES (NON-MEDICAL SERVICES)

This code should be used for any activities that are not health-related, such as education,

employment, job training, social services, other educational, social, job related, and other

activities or services as well as non-Medicaid health related activities.


Activities related to the development of IEPs and attending IAT meetings;

Activities related to immunization requirements for school attendance;

Performing activities that are specific to instructional, curriculum, student-focused areas;

Compiling, preparing, and reviewing reports on textbooks or attendance;

Enrolling new students or obtaining registration information;

Providing general supervision of students (e.g., playground, lunchroom);

Conferring with students or parents about discipline, academic matters or other school-

related issues;

Monitoring student achievement;

Evaluating curriculum and instructional services, policies, and procedures;

Participating in or presenting training related to curriculum or instruction (e.g., language

arts workshop or computer instruction);

Providing academic instruction (including lesson planning), grading, and (instructional or

educational) testing;

Having a parent/teacher conference about a student’s educational progress;

Translating an academic (e.g., social studies) test for a student;

Providing individualized instruction (e.g., math concepts) to a special education student;

Performing clerical activities specific to instructional or curriculum areas.

27

CODE 6: MEDICAID PROGRAM OUTREACH

School provider employees should use this code when performing activities that inform eligible

or potentially eligible individuals about Medicaid and how to access it. This code should also be

used when describing the range of services covered under Medicaid, how to obtain them, and the

benefits of Medicaid preventive services. Both written and oral methods may be used. Include

related paperwork, clerical activities or staff travel required to perform these activities.

NOT DISCOUNTED: Outreach campaigns directed to the entire population to encourage

potential Medicaid eligibles to apply for Medicaid are allowable, and the costs do not have to be

discounted by the Medicaid percentage. These campaigns are essentially eligibility outreach

campaigns. Outreach campaigns directed toward bringing Medicaid eligibles into services

provided through Medicaid are allowable and the costs also do not have to be discounted by the

Medicaid percentage. These campaigns are service campaigns, targeted on specific Medicaid

services, such as information about Early and Periodic Screening, Diagnosis and Treatment

(EPSDT) and managed care.

A health education program or campaign may be allowable as a Medicaid administrative cost, if

it is targeted specifically to Medicaid services and for Medicaid eligible individuals, such as an

educational campaign on immunization addressed to parents of EPSDT children. If the entire

campaign is focused on Medicaid, the costs need not be discounted. Health education programs

or campaigns or component parts of health education programs or campaigns that are general in

nature such as oral hygiene education programs, are not allowable as a Medicaid administrative

cost. Immunization programs required by state law and the associated outreach campaigns are

not eligible for Medicaid administrative claiming. Time spent on immunization programs should

be coded to Code 6.

Outreach may consist of discrete campaigns or may be an ongoing activity, such as: sending

teams of employees into the community to identify children who could benefit from the health

services provided by Medicaid as part of a Medicaid outreach campaign; contacting pregnant and

parenting teenagers about the availability of prenatal and well-child care through Medicaid;

establishing a telephone or walk-in service for referring persons to Medicaid services or

eligibility offices; operating a drop-in community center for underserved populations, such as

minority teenagers where Medicaid eligibility and service information is disseminated. Certain

outreach campaigns may be directed toward bringing specific high-risk populations, for example,

bringing low-income pregnant women or substance abusers into health care services offered

through Medicaid. Report under this code only that portion of time spent in these activities that

specifically address Medicaid outreach. Report the non-Medicaid portion of these outreach

campaigns under Code 6 (for example, general health education programs and Child Find).


Informing students and their families about the availability of Medicaid services, such as

Early Periodic Screening, Diagnosis & Treatment (EPSDT);

28

Developing and presenting materials to explain EPSDT and Medicaid services that are

available to Medicaid-eligible children in the district. School developed outreach

material should have prior approval of ODJFS;

Participating in a presentation to local girls’ and boys’ club staff to inform them of the

school’s efforts to identify children in need of Medicaid services provided by the schools

and give them information about how to refer a student who is potentially in need of

Medicaid services.

Preparing and distributing printed materials to day care centers and local physician

offices about Medicaid and the school’s efforts to assist children to access Medicaid

services provided by the schools.

Assisting the Medicaid agency to fulfill objectives of the EPSDT program by informing

Medicaid eligible and potential Medicaid eligible children and families about the benefits

of preventative medical/mental health services of the Medicaid Program.

29

CODE 7: OUTREACH (NON-MEDICAID PROGRAM)

School provider employees should use this code when performing activities that inform eligible

or potentially eligible individuals about social, educational, legal or other services not covered by

Medicaid and educational programs and how to access them. This code should also be used

when describing the range of benefits covered under the NON-Medicaid programs and how to

obtain them and for IDEA mandated child find activities to identify and locate children with

learning disabilities. Both written and oral methods may be used. Include related paperwork,

clerical activities or staff travel required to perform these activities.

Child Find activities are coded here.


Conducting general health education programs or campaigns addressed to the general

population;

Participating in IDEA mandated child find activities to identify and locate children with

learning disabilities within the school provider.

Scheduling and promoting activities that educate individuals about the benefits of healthy

lifestyles and practices;

General health education programs or campaigns addressed to the general population

(e.g., DARE, dental hygiene, antismoking, alcohol reduction, etc.);

Outreach campaigns directed toward encouraging persons to access social, educational,

legal or other services not covered by Medicaid, such as Free and Reduced Lunch,

Temporary Assistance for Needy Families (TANF) and Women Infants and Children

(WIC);

Helping children and their families use health resources, including their own talents and

knowledge effectively and efficiently.

Non-Medicaid portions of general outreach campaigns;

Child Find activities;

Activities related to Immunization programs required by state law and the associated

outreach campaigns

30

CODE 8: FACILITATING MEDICAID PROGRAM ELIGIBILITY DETERMINATIONS

School provider employees should use this code when assisting an individual in becoming

eligible for Medicaid. Include related paperwork, clerical activities or staff travel required to

perform these activities.

This activity does not include the actual Medicaid eligibility determination.


Informing students and their parents about the Medicaid Program and referring them to

the Department of Job and Family Services to make an application;

Assisting individuals to provide third party resource information at Medicaid eligibility

intake;

Explaining Medicaid eligibility rules and the Medicaid eligibility process to prospective

applicants;

Assisting an applicant to fill out a Medicaid eligibility application;

Gathering information related to the application and eligibility determination from a

client, including resource information and third party liability (TPL) information, as a

prelude to submitting a formal Medicaid application;

Providing necessary forms and packaging all forms in preparation for the Medicaid

eligibility determination.

31

CODE 9: FACILITATING NON-MEDICAID PROGRAM ELIGIBILITY DETERMINATIONS

School provider employees should use this code when helping an individual to become eligible

for NON-Medicaid programs, such as Ohio Works First, Food Stamps, TANF and WIC. Include

related paperwork, clerical activities or staff travel required to perform these activities.


Informing students and their parents about programs such as cash assistance, food

stamps, WIC, day care, legal aid, and other social and educational programs and referring

them to the appropriate agency to make an application;

Developing and verifying initial and continuing eligibility for the Free and Reduced

Lunch Program. When a school provider employee is verifying a student’s eligibility or

continuing eligibility for Medicaid for the purpose of developing, ascertaining or

continuing eligibility under the Free and Reduced Lunch Program, report that activity

under this code;

Explaining eligibility rules and the eligibility process for TANF, food stamps, WIC, etc.

to prospective applicants;

Assisting an applicant to fill out eligibility applications for such non-Medicaid programs

as TANF, WIC, and food stamps;

Gathering information related to the application and eligibility determination for non-

Medicaid programs from a client;

Providing necessary forms and packaging all forms in preparation for the non-Medicaid

eligibility determination.

32

CODE 10: REFERRAL, COORDINATION, AND MONITORING OF MEDICAL SERVICES

School provider employees should use this code when making referrals to other medical service

providers, coordinating, and/or monitoring the delivery of medical, including Medical, services.

Include related paperwork, clerical activities or staff travel required to perform these activities.

Please use Code 1, when conducting any screening, referral, coordination, and monitoring

activities that fall under the definitions of Direct Medical Services.

Please use Code 3, when conducting any screening, referral, coordination, and monitoring

activities that fall under the definitions of Targeted Case Management.


Making referrals for and/or coordinating medical or physical examinations and necessary

medical evaluations;

Making referrals for and/or scheduling EPSDT screens, interperiodic screens and

appropriate immunizations;

Providing information about Medicaid EPSDT screening (e.g., dental, vision) in the

schools that will help identify medical conditions that can be corrected or ameliorated by

services covered through Medicaid;

Referring students for necessary medical health, mental health, or substance abuse

services covered by Medicaid;

Arranging for any diagnostic or treatment services, which may be required as the result of

a condition identified during the child’s EPSDT screen;

Gathering any information that may be required in advance of these health referrals or

evaluations;

Working with children, their families, other staff and providers to identify, arrange for,

and coordinate services covered under Medicaid that may be required as the result of

screens, evaluations or examinations;

Participating in a meeting to coordinate or review a student’s health related needs for

services covered by Medicaid. This example specifically excludes IEP activities;

Providing follow-up contact to ensure that a child has received the prescribed medical

service and to provide feedback whether further treatment or modification of existing

treatment are required;

33

Coordinating the completion of the prescribed services, termination of services, and the

referral of the child to other Medicaid service providers as may be required to provide

continuity of care;

Providing health related information on the child’s medical services and plans to other

staff from Medicaid service providers, when skilled medical knowledge is not required

34

CODE 11: REFERRAL, COORDINATION, AND MONITORING OF NON-MEDICAL SERVICES

School provider employees should use this code when making referrals for, coordinating, and/or

monitoring the delivery of social, educational, legal or other services not covered by Medicaid.

Include related paperwork, clerical activities or staff travel required to perform these activities.


Making referrals for and coordinating access to social and educational services such as

child care, employment, job training, driver education training, clothing assistance, and

housing;

Making referrals for, coordinating and monitoring the delivery of child health screens

(vision, hearing, scoliosis).

Making referrals for, coordinating, and monitoring the delivery of scholastic, vocational,

and other non-health examinations;

Participating in a meeting/discussion to coordinate or review a student’s need for

scholastic, vocational, and non-health related services not covered by Medicaid;

Monitoring and evaluating the non-medical components of the individualized plan as

appropriate.

35

CODE 12: IEP TRANSPORTATION COORDINATION AND TRANSLATION FOR MEDICAL SERVICES

School provider employees should use this code when ASSISTING an individual to obtain

transportation to medical services, or obtaining translation services for the purpose of accessing

medical services. Include related paperwork, clerical activities or staff travel required to perform

these activities.

NOTE: The provision of transportation service must be coded to either Activity Code 1: IEP

Direct Medical Services, or Activity Code 2: non-IEP Direct Medical Services.

Non-medical transportation and translation activities should be reported under Activity Code 10

(Transportation and Translation for Non-medical Services). Reporting under this activity should

not duplicate activities reported under Activity Code 1.


Scheduling or arranging recipient transportation to medical treatment required as the

result of an evaluation or examination;

Arranging for or providing translation services that assist the individual to access and

understand necessary care or treatment.

36

CODE 13: NON-IEP TRANSPORTATION COORDINATION AND TRANSLATION FOR NON-

MEDICAL SERVICES

School provider employees should use this code when ASSISTING an individual to obtain

transportation to services such as vocational, educational or other non-medical programs, or

accompanying the individual to services not covered by Medicaid. This code should also be

used by school employees who provide translation services related to social, vocational, or

educational programs and activities separate from activities referenced in other codes. Include

related paperwork, clerical activities or staff travel time required to perform these activities.


Scheduling or arranging transportation to social, vocational, and/or educational programs;

Arranging for or providing translation services that assist the individual to access and

understand non-medical services;

Arranging for or providing signing services that assist the individual to access and

understand non-medical programs and activities.

37

CODE 14: PROGRAM PLANNING, DEVELOPMENT, AND INTERAGENCY COORDINATION FOR

MEDICAL SERVICES

School provider employees should use this code when performing activities associated with

program planning and the policy development of strategies to improve the coordination and

delivery of medical services to school age children. This code should be primarily used by

employees whose position descriptions include these functions. Include any paperwork, clerical

activities or staff travel required to perform these functions. Use Activity Code 3 when

coordinating IEP health related activities and for OMSP allowable Targeted Case Management.


Working with other agencies providing Medicaid services to improve the coordination/

delivery of services, to expand their access to specific populations of Medicaid eligibles,

and to improve collaboration around the early identification of medical problems;

Containing Medicaid costs and improving services to children as part of the EPSDT

program;

Reducing overlap and duplication in Medicaid services, and closing gaps in the

availability of services, especially for children;

Focusing Medical services on specific populations or geographic areas;

Defining the scope of each agency’s Medical service in relation to the other;

Developing strategies to increase Medicaid system capacity and close Medicaid covered

service gaps; includes analyzing Medicaid data related to a specific program or group;

Recruiting new medical providers;

Providing technical assistance and support to new providers;

Providing information to providers on medical policy and regulations;

Developing medical service/provider directories;

Working with medical resources, such as the managed care plans, to make good faith

efforts to locate and develop health services referral relationships;

Discussing medical health programs, needs and service delivery requirements with

specialists for future referral.

Interagency coordination to improve delivery of Medical services;

Developing resource directories of Medical services. Code development of Medical

service/provider directories to Activity Code 12 (Health Related Provider Relations).

38

CODE 15: PROGRAM PLANNING, DEVELOPMENT, AND INTERAGENCY COORDINATION FOR

NON-MEDICAL SERVICES

This code should be used by school staff when performing activities associated with the

development of strategies to improve the coordination and delivery of non-medical services to

school-age children, and when performing collaborative activities with other agencies. Non-

medical services may include social, educational, and vocational services. Include any

paperwork, clerical activities or staff travel required to perform these functions.


Identifying gaps or duplication of other non-medical services (e.g., social, vocational, and

educational programs) to school age children and developing strategies to improve the

coordination of these services;

Developing strategies to increase the capacity of non-medical school programs;

Monitoring the non-medical delivery systems in schools;

Evaluating the need for non-medical services in relation to specific populations or

geographic areas;

Analyzing non-medical data related to a specific program, population or geographic area;

Conducting external relations related to school educational issues / matters;

Developing procedures for tracking families’ requests for assistance with non-medical

services and the providers of such services;

Analyzing non-medical data related to a specific program, population, or geographical

area;

Recruiting new education and general district personnel, including personnel that provide

IDEA non-health related activities;

Recruiting with outside agencies regarding social and education programs, for example

agencies that assist with childcare and housing assistance;

Providing technical assistance and support to new staff, including orientation;

Developing staff directories;

Developing non-medical referral sources.

Defining the scope of each agency’s non-medical service in relation to the other;

39

Developing advisory or work groups of professionals to provide consultation and advice

regarding the delivery of non-medical services to the school populations;

Developing non-medical referral sources;

Coordinating with interagency committees to identify, promote and develop

non-medical services in the school system.

40

CODE 16: ALLOCABLE GENERAL ADMINISTRATION

School provider employees should use this code when engaged in certain general administrative

activities. Include related paperwork, clerical activities, or staff travel required to perform these

activities. This code should also be used by all school provider employees when on break or on

any form of paid leave. It should also be used when engaged in general administrative activities.


Training (not related to curriculum or instruction);

Establishing goals and objectives of health-related programs as part of the school’s

annual or multi-year plan;

Reviewing school or district procedures and rules;

Attending or facilitating general school or unit staff meetings or board meetings;

Providing general supervision of staff, including supervision of student teachers or

classroom volunteers, and evaluation of employee performance;

Performing administrative or clerical activities related to general building or district

functions or operations;

Reviewing technical literature and research articles.

Paid leave time: sick, vacation, personal, jury duty, military, bereavement, etc.

Processing payroll/personnel-related documents;

Maintaining inventories and ordering supplies;

Developing budgets and maintaining records;

Providing executive direction.

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